MPCA NEWS

A briefing held on February 2, 2016 by the bipartisan Congressional Primary Care Caucus, the Patient-Centered Primary Care Collaborative (PCPCC) unveiled its latest report highlighting new evidence that links the Patient-Centered Medical Home (PCMH) with lower costs and improved health care quality.

The report highlights thirty primary care PCMH initiatives from around the country measuring costs and utilization of services and includes an analysis of the findings.

In Michigan, 69% of Health Centers have obtained PCMH recognition. The national average is 59%.

Discussions of payment reform continue both at the national and state level. In order to prepare for a transformed payment and service delivery model, it is important for the MPCA and health centers to not only have strong understanding of the payment reform efforts underway, but to critically assess the current capabilities of Health Centers and develop collaborative strategies to accelerate the transformation.

MPCA is working on a multi-pronged approach to supporting health centers through this transformation. This fall Michigan Health Centers piloted the Payment Reform Readiness Assessment. The results from the Assessment have been compiled and are being used to guide upcoming training offerings. In the coming months, MPCA will be hosting a number of trainings both in person and via webinar on topics identified through the assessment. We are excited to be working with several national experts to develop the content for these trainings. In addition, MPCA has also compiled a webpage of payment reform resources for your review and to provide background to your staff and boards. We encourage you to check out the resources and to alert us of any additional resources that would be valuable to add.

If you are interested in serving on the Payment Reform Workgroup, please email Pam Gourwitz. Pam will serve as the staff lead on Payment Reform technical assistance moving forward.

Applications for Tobacco Use Reduction Now Being Accepted

Michigan Primary Care Association (MPCA) and the Michigan Department of Health & Human Services (MDHHS) have partnered to provide customized technical assistance to a select number of Michigan Health Centers with the goal of reducing tobacco use among patients.

To that end, MPCA is now accepting applications for a seven month project, as part of the Getting to the Heart of the Matter in Michigan grant titled Health Systems Change for Treating Tobacco Dependence in Dental Clinics. The project is designed to support Health Centers in delivery of evidence-based tobacco dependency treatment, improve processes for referral and tracking while optimizing workflow, and health IT. MPCA will select up to five Michigan Health Centers through the application process. Applications will are due on February 19, 2016 by 5 pm ET and should be sent to Lindsay Sailor.

Civil legal aid can improve health outcomes and decrease costs of health care by addressing social determinants of health. For example, civil legal aid lawyers can help Health Center patients access food stamps to facilitate improved nutrition; prevent evictions and utility shut-offs to ensure stable, safe, and warm housing; clear a criminal record to improve employment opportunities; or obtain a restraining order to protect against domestic violence. Medical-Legal Partnerships (MLPs) leverage the valuable role lawyers can play to address social determinants by integrating legal care into patient care teams. The impact of MLPs is magnified in Health Centers since, according to the National Center for Medical-Legal Partnerships (NCMLP), “every low-income person has 2-3 unmet civil legal needs that create barriers to healthy eating, healthy housing, employment and safety.”

Since legal aid services were deemed “enabling services” by Heath Resources and Services Administration in 2014, the MLP model has become increasingly popular and viable among Federally Qualified Health Centers. MLPs will become even more valuable as payment models shift towards value and outcome based payments.

Michigan Primary Care Association (MPCA) began exploring this topic at our 2015 Annual Conference; now is the perfect time to continue learning about MLPs through several learning opportunities kicking off with an MPCA webinar, Addressing Social Determinants of Health Through Medical-Legal Partnerships on February 23 from 1 - 2 pm ET. Save the date of this webinar as registration is not yet available and make plans to learn more about the MLP model and civil legal aid services in Michigan.

In addition, MPCA plans to convene an in-person meeting for interested Health Centers and legal partners later this spring; stay tuned and plan to join us!

Please email Colleen Healy with questions or if you cannot attend the MPCA webinar but would like to stay in the loop on MPCA’s work to support the MLP model in Michigan Health Centers.

This webinar aims to help participants understand the MLP approach and field and how it aligns with existing Health Centers’ services and priorities (especially enabling services); the skills, resources and capacity of the civil legal aid community; and the opportunities for multi-sector engagement across all Health Centers and civil legal aid offices with a focus on population health strategies.

Each spring, the National Center for Medical-Legal Partnerships hosts a national conference to bring together health care providers, lawyers, social workers, and public health professionals to share ideas and best practices for integrating legal care into health care to combat health-harming social conditions. This year’s Summit will pay particular attention to how partners are re-orienting their practice, policies or data collection efforts in the interest of more efficient and meaningful collaboration. Additional information is available here.

Please note that you must be logged in to MPCA’s online community when registering for MPCA-hosted events to receive a discounted rate if your organization is an MPCA member. If you are subscribed to the MPCA eUpdate, you have a profile in MPCA's online community. If you have forgotten your password, please use the "forgot password" link under the sign-in box to reset your password. If you need further assistance, please contact info@mpca.net.

MPCA posts job openings at Michigan Health Center Program grantees, Michigan FQHC Look-Alikes, and MPCA active member organizations. To submit a job opening for posting in the online MPCA Career Center and in the MPCA eUpdate, email the job title, a brief overview, a bulleted list of qualifications, and instructions on how to apply to info@mpca.net with Job Posting in the subject field.

Flint Water Crisis - An Update from Genesee Community Health Center & Hamilton Community Health Network

As the Flint Water Crisis continues to unfold, resources continue to take shape alongside the development of short, mid and long term planning. Michigan Primary Care Association reached out to the two Michigan Health Centers serving Flint residents to gain additional insight into the growing demand for testing, monitoring, education, outreach and mental health services – both now and into the unforeseeable future.

Two Michigan Health Centers serve the residents of Genesee County – Hamilton Community Health Network, Inc. and Genesee Community Health Center. Hamilton Community Health Network, a Federally Qualified Health Center, receives funding as a Community Health Center (330E) and a Public Housing Health Center (330I). Genesee Community Health Center, also a Federally Qualified Health Center, receives funding as a Health Care for the Homeless Health Center (330H) and a Public Housing Health Center (330I).

Inside Hamilton Community Health Network, patient health is a growing concern. “We are seeing an increase in the number of patients visiting our three medical facilities affected by the water crisis,” said Cynthia Edwards, Director of Marketing and Planning for Hamilton. “At our main site, located at 2900 N. Saginaw, we show a 7 percent increase in patient visits from November 2015 to December 2015 with a 6.6 percent increase in January 2016.” Edwards adds “we are seeing an increase in patients who are requesting to have lead level blood testing along with other labs tests they are having done as well as simply coming in and requesting to have lead testing only."

In addition to an increase in testing, Hamilton has also seen an increase in adult and children skin rashes and a predictable increase in parental concern with their children’s well-being. “Residents of Flint are not only dealing with the physical risks associated with exposure to lead,” mentions Clarence Pierce, CEO for Hamilton, “but the economical and emotional impact from the crisis as well. Our providers are encountering parents who are concerned about their children, particularly the mental health of their children, now and in the future.”

In total, Hamilton has five sites serving the residents of Genesee County. At their North Pointe site, which has been largely affected by the water crisis, there was a 12.5 percent increase in patients seen from November 2015 to December 2015. Their Burton site also experienced a slight increase in patients at 8.2 percent as some residents are also on the Flint water pipeline. Hamilton anticipates the numbers will continue to grow as awareness grows and additional resources become available.

The story is similar at Genesee Community Health Center where patient screening for lead testing continues to increase. “The population we serve at Genesee already has such complex needs that the water crisis just adds one more layer to the numerous issues our patients face each day,” said Honor Potvin, Interim Executive Director at Genesee Community Health Center. “Our social workers estimate they have provided therapy on water crisis related mental health issues to 400 – 600 patients over the last four weeks and our health coaches estimate providing emotional support and/or assistance obtaining bottled water and filters to over 4,000 people in the Flint area since the beginning of January.”

“We recently obtained a lead screening device that can provide results within three minutes with just a finger prick. This will further assist in identifying individuals who should be prioritized for a full blood level test via a venous blood draw.”

In addition to tracking the Blood Lead Levels of all children under the age of six who receive services at the Health Center, Genesee is sending out letters and directly contacting families to bring them in for testing while simultaneously working to educate families on the meaning of test results and the importance of continuous monitoring. “In addition to understanding what a test result means there is also a need to have families undergo continuous monitoring to ensure an increase or decrease in exposure is tracked and treated,” said Potvin. “An exposure to lead may have occurred in the past, but would not show up in a current test…monitoring is imperative at both ends of the spectrum.”

In addition to working to educate and test patients, Genesee is working on securing the necessary supplies for patients, acquire additional lead testing supplies and securing funds to help get their mobile unit operational. “While we are working to becoming a water and filter distribution site, we are providing bottled water for our patients,” adds Potvin. “While we need additional lead testing supplies, we recently received a lead screening device that can provide results within three minutes with just a finger prick enabling staff to quickly identify individuals who should be prioritized for a full blood level test via venous blood draw.” Securing additional funds to get their mobile unit is imperative “as it is a key method to connect with disenfranchised and transient community members, who have surely been affected,” mentions Potvin. “This is our number one ask at this time as we work to secure the necessary resources and funding support to enable the mobile unit to be operational and out in the community providing outreach, education and testing.”

Community partnerships have been a focus in planning a long-term response and both Health Centers have been working together alongside the Michigan Primary Care Association, Hurley Medical Center, the Greater Flint Health Coalition, the University of Michigan, Genesee Health System and Health Resources and Services Administration to name a few. Genesee Health System, alongside Substance Abuse and Mental Health Services Administration and the US Public Health Service have planned and held community forums, which have resulted in better risk communication and as of late, the formation of the Flint Community Resilience Group to help coordinate and plan a behavioral health response plan.

In addition, the Michigan Child Collaborative Care Program (MC3), a program from the University of Michigan, has just been approved to provide Genesee county residents free child psychiatry consultations via Primary Care Providers as well as telepsychiatry evaluations and follow-up’s for a fee. MC3 provides psychiatry support to primary care providers in Michigan who are managing patients with mild to moderate behavioral health problems.

In addition to the Federal and State assistance and declarations, MPCA has a response team working with both Hamilton and Genesee to provide assistance focused on the Health Center needs including resource acquisition, partner engagement and the identification of short, mid and long term Health Center needs.

On January 29, 2016, Governor Snyder signed supplemental spending for Flint in the amount of $28 million that will:

On February 4, 2016, the Michigan Senate voted unanimously for the passage of a $30 million funding request to aid the city of Flint with credits for water and sewage bills until the state and federal officials the water is safe to consume. The funding request now heads to the House for consideration.

Apply for the 2016-17 Building Healthy Communities Program

Building Healthy Communities is a school-wide initiative that works with schools and their communities to teach kids healthy habits and prevent childhood obesity. The program has reached more than 180,000 students in more than 390 Michigan schools since its inception in 2009.

The program is open for all Michigan schools, grades K-12, to apply. There are two deadlines to apply, depending up the program:

Elementary School Program: a comprehensive model designed for elementary schools where multiple healthy eating and physical activity opportunities and education are embedded throughout the school environment. Deadline to apply: March 30, 20126

Step Up for School Wellness Program: a flexible model designed for all grade levels, K – 12, to help schools make targeted improvements to their environment by allowing them to select the components that will best meet their needs. Deadline to apply: March 18, 2016

MDHHS Accepting Public Comments on Medicaid Transition to Managed Care Common Formulary

On February 1, 2016, the Michigan Department of Health & Human Services (MDHHS) published a proposed Medicaid policy outlining the minimum requirements health plans must meet as they transition their members to the Managed Care Common Formulary under the next Comprehensive Health Plan Contract. The policy draft states that health plans will begin transitioning members during a six-month period starting April 1, 2016.

Public comments on the proposed policy will be accepted by MDHHS through March 1, 2016 and Michigan Primary Care Association (MPCA) will submit comments on the proposed policy. If you would like to include your comments with MPCA's submission, please send your comments to comments to Colleen Healy no later than February 19, 2016.